Archive for May, 2011

In the last week I have received a flood of e-mails asking my opinion about an article, “Scientists cure cancer, but no one takes notice.” The sensational theme is a familiar one – scientists hit upon a cure for cancer, but since the drug in question is already off patent (or is “natural”) the pharmaceutical industry is not interested in developing it. The more conspiracy-minded take it a step further and declare that “Big Pharma” will keep anyone else from developing it either.

Most of those e-mailing me saw the skeptical red flags in this story, but still many found the idea intriguing. Like most urban legends – something about the story resonates with our hopes and/or fears. The story rides this emotional wave, now supercharged by social media.

In fact, this is an old story about DCA (which I will get into below). The article that has been going around is four years old – there is no date on the article itself, but I recognize the story from several years ago (it has made the rounds numerous times) and there are four-year-old comments on the article. But, someone posted the article on their Facebook page, and someone else tweeted it, and it was retweeted and linked to by other Facebook pages and voila – the magic of the internet has breathed life into a dessicated urban legend.

The struggle for the very essence of modern medicine continues. The vast majority of health care professionals carry on, largely oblivious to the fact that a small cadre of upstarts are trying to change the nature of modern medicine – to make it less science-based and more friendly to not just unconventional treatment, but downright unscientific notions.

Andrew Weil is one of the more prominent figures in the complementary and alternative medicine (CAM) movement, although he prefers the term “integrative”. He and co-authors, Scott Shannon and Bonnie Kaplan, wrote a commentary in which they call for changes in the way medical decision-making (MDM) is taught and practiced. It’s a very sly commentary in that- whenever you focus attention on any complex issue, like MDM, there are thoughtful criticisms you can bring to bear. But they use this as an opportunity to do what CAM proponents typically do – build a straw man of modern medicine and then propose a watering down of the much needed scientific standards on which medicine is built.

Over the last 20 years the prevalence of autism (now part of autism spectrum disorder, ASD) has been increasing. The medical community is largely agreed that this increase is mostly due to expanding the diagnostic category and greater efforts at surveillance. There remains some controversy over whether or not these factors explain all of the measured increase, or if there is a small real increase hidden in there as well. But largely – we are finding more children with ASD because we are casting a wider net with smaller holes.

If this is true, then we do not yet know what the true prevalence of ASD is. There must be a pool of undiagnosed children out there. Eventually the measured prevalence will hit the ceiling of the true prevalence (unless, of course, we expand the definition further) – but where is the ceiling?

In my opinion society is best served with open and vigorous debate about important topics of the day. Such debates are most effective, however, when proponents of opposing views are actually engaging directly with the claims and beliefs of the other side. This requires effort – to understand what the other side believes and why they believe it. This should be taught as a basic intellectual skill in school. Whenever confronted with a controversy, make a sincere effort to understand the best case that each side is putting forward.

In my (admittedly biased) experience, what I will call “fair engagement” is more the exception than the rule. It is easy to slip into accepting a straw-man caricature of the other side. We all do it to some degree. The danger for skeptics is to focus on the most extreme examples of a belief as if they are representative, while ignoring the more reasonable (if still wrong) end of the spectrum. But while there is a continuum, there are those who make a sincere effort to treat their opponents fairly, and those who are stramenticidal maniacs (sorry for my lack of Latin scholarship, but that’s as close as I can come to someone who likes to murder straw men).

The alternative medicine (CAM) community in particular seem to enjoy engaging with straw men of their opponents. It is partly a result of their genuine lack of understanding of our criticisms, but it is also a result of their propaganda. The CAM community (at least collectively) have mastered the marketing of their ideas. They manage to frame the discussion in a way that completely distorts the actual points that are in dispute – in their favor.

I was recently pointed to this news report from a local Fox affiliate – about an inventor who has developed an engine that can burn water. This is a topic well-covered in skeptical and scientific circles. The inventor, Denny Klein, makes all the typical claims that are made for such systems.

Briefly – you cannot use water as a fuel source. What Klein is doing is using electricity to electrolyze water into hydrogen and oxygen. Then he burns the hydrogen gas back with oxygen, creating a flame and water. The news report begins with his demonstration of his “oxyhydrogen” torch. But then it goes on to claim that Klein can also use his technique to fuel a car. The problem with this approach is that it takes more energy to split the water into hydrogen and oxygen then is recouped by burning the hydrogen back with oxygen. Water is therefore not a source of energy. At best it is a source of hydrogen which can be used to store energy – but you have to put the energy into it in the first place. All Klein’s process adds is an unnecessary step that decreases engine efficiency.

Klein’s device is nothing new, and his crank claims for it only demonstrate his lack of Google skilz. In fact, the oxyhydrogen torch was the first type of welding torch developed. This technology is 200 years old – it was first developed by chemist, Robert Hare.

Chronic fatigue syndrome (CFS) is an enigmatic disorder. The primary symptom is debilitating fatigue that does not resolve with rest. Fatigue, however, is a very non-specific symptom, meaning that it can potentially result from many underlying causes. Anything that saps the energy our body uses to function will cause fatigue. In part CFS is a diagnosis of exclusion – it is based upon the presence of fatigue in the absence of any identifiable underlying cause. Therefore not everyone with chronic fatigue has CFS.

The non-specific nature of the clinical syndrome also frustrates our attempts to find the underlying cause or causes (it may, in fact, be many diseases all with a similar clinical presentation). So many things can potentially cause chronic fatigue – where do we begin. However, a chronic viral infection has long been suspected as a likely cause, at least in some cases.

Recent studies have found a potential association between CFS and a retrovirus called XMRV (xenotropic murine leukemia virus-related virus). This has led some desperate patients with CFS to take anti-retroviral drugs (used mostly to treat HIV – another retrovirus) off label in order to treat their CFS. But these studies, while intriguing, were considered preliminary.

This is very good news. It is heartening to occasionally see a state medical review board actually do their job and discipline physicians who are practicing abject quackery. I am only partly blaming state boards for their general lack-luster performance in this area. In many cases their hands are tied by state laws designed specifically to hamper their ability to discipline unscientific or substandard medical practices.

This week on the SGU I will be interviewing Jon Ronson about his latest book, The Psychopath Test, just being released in the US. I am not going to write about the book here (I will do that after the interview, although I have already read a preview copy). Rather, as a prelude to the interview I want to discuss some background thoughts about how we think about brain function in the context of psychology and psychiatry. What I am actually going to give you is my own current synthesis, acknowledging that there is lots of wiggle room for interpretation and opinion, and my own thoughts have been constantly evolving over the years.

Hardwiring

It is somewhat of a false dichotomy to think of brain function in terms of hardware and software. That compelling computer analogy tends to break down when you apply it to the brain, because in the brain hardware and software are largely the same thing. Memories are stored in the same neurons that make up the basic structure of the brain, and experiences can alter that structure (to some degree) over time. The brain is neither hardware nor software – it’s wetware.

But it is still useful to think of brain function in terms of long-term structures in the brain – modules and networks that make up the basic functioning of the brain and change slowly (if at all) over time, and short term structures and processes that subsume short-term memory, our immediate experiences, mood, and emotions, and our attention and thoughts. The latter is as close as we get to “software”.

The existence of this creature remains at best controversial, with the bulk of the scientific community skeptical. The evidence so far put forward consists of photos and video that are either out-of-focus or at such a distance that definitive identification is not possible. Proponents focus on questionable analysis of minute details of their blurry videos in order to make their case, and excuse the lack of better evidence by that fact that their quarry is rare, wary, and lives only in the deep wilderness.

I am talking, of course, about the ivory-billed woodpecker.

The ivory-billed woodpecker is a larger cousin to the extant pileated woodpecker, but it was believed to have gone extinct in the 1940s. However, recent putative sightings have raised the possibility that a small population still persists in the deep swamps where they roam. In most of the videos and photographs shown so far the subject does appear to be a large woodpecker – but the question remains if the birds seen in these images are a pileated woodpecker or an ivory-billed. There are differences in markings and flying characteristics, but the fleeting and distant images do not allow for a clean distinction.